Hypertension in men is frequently undiagnosed and is by far the biggest preventable cause of death in the UK, reports Kathy Oxtoby…

Hypertension is a common condition experienced by around one in three adults in the UK.¹ However, if undiagnosed and unmanaged, high blood pressure can have serious, even fatal, consequences.

Hypertension is called ‘the silent killer’ because most people do not have any symptoms and therefore do not realise their blood pressure is raised, says the British and Irish Hypertension Society (BIHS).

Left untreated, raised blood pressure damages the heart and blood vessels and leads to an increased risk of strokes, heart attacks, kidney disease and some forms of dementia. In the UK, heart and circulatory diseases cause around a quarter of all deaths - that's more than 460 each day - or one death every three minutes, says BIHS.

And yet blood pressure is “the biggest preventable cause of death in the UK by far - and we need to do far more about it. It’s a walking time bomb,” says Professor Graham MacGregor, chair of Blood Pressure UK.

Half of people with high blood pressure are not diagnosed or receiving treatment.² In England alone, there are more than five million people that are undiagnosed.³ And in England, a greater percentage of men (31 per cent) have high blood pressure than women (26 per cent).¹

No specific cause…

In most cases there is no specific cause for high blood pressure - known as ‘primary hypertension’. However, individuals who eat too much salt in their diet, are overweight, drink too much alcohol, or smoke may be more likely to develop raised blood pressure.

In rare cases, BIHS says there may be an underlying condition or medication that causes raised blood pressure - known as ‘secondary hypertension’. Secondary causes include kidney disease, hypothyroidism,  pregnancy, and obstructive sleep apnoea.

Drugs and other substances that are associated with raised blood pressure include alcohol, cocaine, amphetamine, hormone therapies, corticosteroids, nonsteroidal anti-inflammatory drugs, stimulants such as methylphenidate, and sympathomimetics in over-the-counter cough and cold remedies, says BIHS.

Pharmacies can play a crucial role in helping to identify and manage hypertension in men. “Men are a hidden population when it comes to health. But pharmacies can offer free blood pressure checks, and if there are any issues we can direct patients to their GP. Our actions can save men’s lives,” says Lindsey Fairbrother, superintendent pharmacist at Goodlife Pharmacy, Hatton.

Professor MacGregor says it’s vital for pharmacists “to be aware of the importance of blood pressure and to seize the opportunity to measure it and help people to get better control of it”.

The new NHS community pharmacy hypertension case-finding service means that pharmacies in England are now able to offer free opportunistic blood pressure checks to people aged 40 and over, to identify hypertension and prevent cardiovascular disease.

Alastair Buxton, PSNC’s director of NHS Services, says: “Subject to appropriate funding being in place, community pharmacy teams are well placed to play a greater role in public health and prevention initiatives, including tackling cardiovascular disease.

“With more than half a million people receiving a heart blood pressure check in their local pharmacy since October 2021, the Hypertension Case-Finding Service has already begun making a big difference to the health of individuals and supports the NHS Long Term Plan’s ambition for prevention of cardiovascular disease,” he says.

Ms Fairbrother says the service is a “brilliant way of speaking to male customers to find out if they have a blood pressure problem or not”. She believes pharmacies need to be proactive about providing this service and offer blood pressure checks while patients are waiting for vaccinations or medication.

Other ways to check for hypertension include ambulatory blood pressure monitoring, which assesses blood pressure during routine daily activities, typically during one 24-hour period.⁴ Home blood pressure monitoring can assesses blood pressure at specific times during the day and night over a longer period of time while the patient is seated and resting.⁴

President of the BIHS, Professor Terry McCormack, says pharmacists “can encourage patients to use a BIHS validated blood pressure monitor and teach them the best way to use that device”. Patients should also be advised that the blood pressure monitors should be replaced after five years, he says.

The BIHS also has a range of resources to support community pharmacists to monitor hypertension, including a blood pressure device validation service. BIHS also collaborates with Blood Pressure UK, which has a range of resources for patients (see resources box).

Offering lifestyle advice can not only help to manage, but also prevent hypertension. “The most important change is to get your salt intake down,” says Professor MacGregor.

Blood Pressure UK recommends to avoid adding salt to food when cooking or at the table. Also avoid using stock cubes, gravy and soy sauce, check food labels and avoid processed foods high in salt, and overall aim to eat less than 6g a day.

Men can also be advised to “increase their fruit and vegetable consumption, lose weight, increase their exercise, and to drink in moderation”, says Professor MacGregor.

Medicines management

Several types of medication can be used to help control high blood pressure. Patients under 55 years of age are usually be offered an ACE inhibitor or an angiotensin-2 receptor blocker (ARB), while those aged 55 or older are usually offered a calcium channel blocker.⁵

As for medicines management advice, NICE has clear guidelines on how to manage patients with high blood pressure (see resources).

BIHS says it is common for individuals to require more than one anti-hypertensive to achieve blood pressure control. This medication is likely to make the patient suffer new side-effects, so awareness of this, and advice to report these side-effects is important.

Ms Fairbrother recommends advising patients to remember to take their medication regularly. “And just because they don’t feel any different, they shouldn’t assume their medication isn’t working and stop taking their tablets,” she says.

“You need to make patients realise that blood pressure is a hidden area - and the only way to know their blood pressure is to get it checked. And with the Hypertension Case-Finding Service, pharmacists have an opportunity to check blood pressure, and save lives.”

Useful resources

BIHS: www.bihsoc.org/

BIHS: www.bihsoc.org/resources/bp-measurement/abpm/

Blood Pressure UK: www.bloodpressureuk.org

The British Heart Foundation: Manage your blood pressure at home. www.bhf.org.uk/informationsupport/support/manage-your-blood-pressure-at-home

NICE Hypertension guidelines: www.nice.org.uk/guidance/ng136. Provides detailed information and management advice on the secondary causes of hypertension.

NHS: www.nhs.uk/conditions/high-blood-pressure-hypertension/

PSNC: Hypertension case finding service in England. www.psnc.org.uk/national-pharmacy-services/advanced-services/hypertension-case-finding-service/

References

1. NHS Digital (2016) Health Survey for England, 2015. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/health-survey-for-england-2015
2. British Heart Foundation (2022) British Heart Foundation UK Factsheet. August 2022. https://www.bhf.org.uk/-/media/files/research/heart-statistics/bhf-cvd-statistics---uk-factsheet.pdf
3. UK Health Security Agency (2017) Health matters: combating high blood pressure. https://ukhsa.blog.gov.uk/2017/01/24/health-matters-combating-high-blood-pressure/
4. Shimbo D, et al. (2015) Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review. Annals of Internal Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638406/#:~:text=ABPM%20assesses%20blood%20pressure%20during,patient%20is%20seated%20and%20resting.
5. NHS (2022) Treatment. High blood pressure (hypertension). https://www.nhs.uk/conditions/high-blood-pressure-hypertension/treatment/